慢性阻塞性肺炎患者内科治疗方法的临床疗效探究

目的：探究内科治疗方法治疗阻塞性肺炎患者的临床疗效。方法选取我院2014年1月～2015年1月收治的64例患者，随机分成两组，观察组患者用多索茶碱治疗，对照组患者用氨茶碱治疗，均治疗一周后，比较两组患者的有效率，得出结论。结果观察组患者的有效率为（30/32）93.8%，对照组的有效率为（21/32）65.6%，两组患者的差异具有统计学意义（P＜0.05）。结论多索茶碱治疗慢性阻塞性肺炎的临床疗效优于氨茶碱，有明显的临床效果，能够有效降低不良反应的发生，提高治愈率。     

Anestesia geral sem opioide e recuperação induzida da anestesia em paciente com distrofia miotônica tipo‐1: relato de caso

Myotonic dystrophy type‐1 (Steinert disease) is an autosomal dominant, progressive multisystem disease in which myotonic crisis can be triggered by several factors including pain, emotional stress, hypothermia, shivering, and mechanical or electrical stimulation. In this report, dexmedetomidine‐based general anesthesia, in combination with a thoracic epidural for laparoscopic cholecystectomy in a patient with Steinert disease, is presented. An Aintree intubation catheter with the guidance of a fiberoptic bronchoscope was used for intubation to avoid laryngoscopy. Prolonged anesthetic effects of propofol were reversed, and recovery from anesthesia was accelerated using an intravenous infusion of theophylline.     

参仙升脉口服液辅助治疗缓慢性心律失常疗效观察

摘 要 目的: 观察参仙升脉口服液辅助治疗缓慢性心律失常的疗效和安全性。方法：缓慢性心律失常患者80例按就诊顺序分为两组。对照组患者采用常规治疗,观察组患者在对照组基础上加用参仙升脉口服液20 ml,po bid。两组均治疗4周。比较两组治疗前后24 h动态心电图变化、临床疗效及药品不良反应。结果：观察组临床总有效率为92.5%,明显高于对照组的70.0%（P＜0.05）。观察组患者治疗后24 h动态心电图检查结果明显优于对照组（P＜0.05）。治疗中两组患者均未出现明显不良反应。结论：常规治疗基础上加服参仙升脉口服液可有效提高缓慢性心律失常的临床疗效,安全性好,具有推广应用价值。     

HPLC同时测定慢性阻塞性肺病患者血浆中的茶碱和1,3-二甲基尿酸

目的 采用HPLC法同时测定慢性阻塞性肺病(COPD)患者血浆中的茶碱及其代谢物1,3-二甲基尿酸(1,3-DMU).方法 色谱柱为Hypersil BDS C18柱(250 mm×4.6 mm,5μm),流动相为乙腈-水(7∶93),流速1 mL·min-1,检测波长280 nm.43名COPD患者连续服用茶碱(100 mg,bid)两周后,测定茶碱及1,3-DMU的血药浓度.结果 茶碱、1,3-DMU的线性范围分别为0.20 ～ 10.00 μg∶ mL-1(r=0.9998)、0.05 ～ 2.00 μg∶ mL-(r=0.9996);日内、日间RSD均≤12.91％,提取回收率分别为77.52％ ～79.22％、71.69％ ～ 74.02％;患者的平均茶碱血药浓度为3.57±1.59 μg∶ mL-1,茶碱和1,3-DMU的浓度呈强相关(r=0.672),1,3-DMU/茶碱为0.064±0.024.结论 所用方法简便、快速、准确,可用于COPD患者茶碱血药浓度的监测,1,3-DMU与茶碱浓度的比值可评估不同个体对茶碱清除率的差异.     

Evidence that cyclic GMP may regulate cyclic AMP metabolism in the isolated frog ventricle

Both acetylcholine and 8-bromo cyclic GMP depress the contractile response of the isolated frog ventricle. An investigation has been made of the effects of both substances on the metabolism of endogenous 3,5 cyclic nucleotides. The levels of adenosine 3′, 5′ cyclic monophosphate (cyclic AMP) and guanosine 3′, 5′ cyclic monophosphate (cyclic GMP) were measured after superfusing preparations with varying concentrations (10^?10 to 10^?4m) of acetylcholine and 8-bromo cyclic GMP. The decline in contractile force was found to be accompanied by a progressive fall in intracellular cyclic AMP and a rise in cyclic GMP levels. Both the decline in contractility and the reduction in endogenous cyclic AMP are attenuated by 10^?4 theophylline. The decline in isometric twitch tension was paralleled, under all conditions, by a quantitatively equivalent reduction in the ratio cyclic AMP: cyclic GMP. The possibility that endogenous cyclic GMP may accelerate the conversion of cyclic AMP to 5 AMP, by stimulating a cyclic GMP-sensitive form of cyclic AMP phosphodiesterase, is discussed.     

Changes in the Biochemical Profiles of Mid-Cervically Located Adenosine A1 Receptors After Repeated Theophylline Administration in Adult Rats

Abstract

Background/Objective: Adenosine A1 receptors localized in the phrenic motoneurons (PMNs), where the axons of the descending bulbospinal respiratory make synaptic contacts, may be involved in theophylline- induced respiratory-related activity in rats. The objective of this study was to characterize the biochemical profiles of adenosine A., receptors in 2 groups of rats: (a) naive and (b) theophylline-treated (3-day oral administration).

Methods: Biochemical binding characteristics of adenosine A1 receptors in the C3 to C5 (PMN) of adult rats were assessed in naive (n = 6) and theophylline-treated animals (n = 6) using [3H]-DPCPX (10 pmol/L to 30 nmol/L), the specific adenosine A1 receptor antagonist in saturation-binding assays. Competition assays used theophylline as the competing ligand (20 mmol/L to 20 pmol/L), and protein concentration was determined with the Bradford assay using a range of standards (0.016-1.0 mg/mL).

Results: In saturation-binding assays in naive animals, the A1 receptor was characterized by a single binding site with Smax and Kd values of 256.00 ± 32.13 fmoi/mg protein and 2.89 ± 0.45 nmol/L, respectively. Analysis of the isotherm in theophylline-treated animals showed 1 site with Smax and Kd values of 219.00 ± 26.3 fmol/mg protein and 0.60 ± 0.21 nmol/L, respectively, and a second site characterized by Smax and Kd values of 492.6 ± 3.15 fmol/mg protein and 14.09 ± 2.06 n mol/L, respectively.

Conclusions: Theophylline administration revealed 2 binding sites on receptors (characterized by the specific adenosine A1 antagonist, [3H]-DPCPX) located in the vicinity of phrenic motoneurons (C3-C5). Alteration of the receptor profiles after theophylline may underlie the respiratory-related actions of the drug.     

Theophylline increases saliva sonic hedgehog and improves taste dysfunction

ObjectiveTo determine changes in saliva sonic hedgehog (Shh) and in taste dysfunction before and after oral theophylline treatment.DesignShh was measured in parotid saliva of both normal subjects and patients with taste dysfunction of multiple etiologies by use of a sensitive spectrophotometric ELISA assay. Taste dysfunction was defined clinically by both subjective inhibition of taste function (including acuity loss) and impaired gustometry.ResultsTheophylline treatment increased patient saliva Shh and improved taste dysfunction both subjectively and by gustometry.ConclusionsBy use of these systematic clinical measurements theophylline can be demonstrated to increase saliva Shh and improve taste dysfunction. These results are consistent with saliva Shh acting as a taste bud growth factor which stimulates stem cells of taste buds to initiate development and perpetuation of taste bud receptors. Measurements of saliva Shh provide an important marker for the presence of taste dysfunction and in the improvement by theophylline treatment.     

Reduced theophylline clearance due to hepatic congestion secondary to right heart failure - A population pharmacokinetic study

Theophylline, a beneficial drug with bronchodilatory and anti-inflammatory effects, is used for the treatment of respiratory diseases. Pulmonary (PC) and hepatic congestion (HC) are secondary to the development of left- and right-sided heart failure (HF), respectively. This study aimed to evaluate the effects of PC and HC on theophylline clearance (CL) by population pharmacokinetic (PPK) analysis with consideration of the severity of HF assessed by the New York Heart Association (NYHA) functional classification. We obtained 710 minimum steady-state concentrations from 201 Japanese bronchial asthma patients with and without HF. PPK analysis was performed by NONMEM. In the analysis, the left ventricular ejection fraction, smoking (SMK), clarithromycin (CAM), sex, and age were also considered as covariates. The final model of apparent theophylline clearance (CL/F) was as follows: CL/F (L/hr/kg) = 0.0465 × 1.40^SMK × 0.870^CAM × 0.863^{HC(+)NYHA II} × 0.634^{HC(+)NYHA III} × 0.586^{HC(−)NYHA IV} × 0.467^{HC(+)NYHA IV}. SMK is a well-known factor that markedly enhances theophylline clearance through the induction of CYP1A enzymes, while CAM has been reported to inhibit CYP3A4. The final model indicates that HF patients with HC show reduced clearance of theophylline depending on the severity of HF. In this study, no effects of PC were observed.     

1305例茶碱血药浓度分析

目的通过分析茶碱的血药浓度分布及影响血药浓度的因素,了解茶碱临床使用的合理情况,使茶碱使用更安全、有效。方法对我院2010～2012年1305例患者的茶碱血药监测结果进行回顾性分析。结果 1305例患者中,血药浓度在5～20μg·mL-1范围的占45.7%,低于5μg·mL-1的占50.9%,而且当年龄超过70岁时,随着年龄的增长,出现中毒血药浓度（＆gt;20μg·mL-1）的可能性越大。结论茶碱血药浓度受多种因素影响,尤其是老年患者,临床使用应进行血药浓度监测,对确保临床安全合理用药具有重要意义。     

Impairment of lymphocyte suppressive system in recent onset insulin-dependent diabetes mellitus. correlation with blood glucose and serum insulin levels

Summary In a previous study, we observed an impairment of the theophylline-induced suppressive system in recent onset IDDM patients, and demonstrated also a correlation with metabolic derangement. The aim of this study was to better investigate the relationship between theophylline sensitivity (ThS) and blood glucose/plasma insulin levels in recent onset IDDM patients subjected to preprogrammed variations by an insulin/glucose clamp with artificial pancreas. Eight patients were studied within 8 weeks from the onset of IDDM. ThS was evaluated as the ability of theophylline to inhibit blastogenic response of peripheral blood lymphocytes (PBL) to Concanavalin A (ConA), after 120 min preincubation of the cells. All patients were connected to an artificial pancreas. Through i.v. continuous insulin infusion (0.02 U/kg/h) and/or i.v. continuous glucose and saline infusion, the following experimental conditions, lasting at least 1h, were obtained: T1: relative euglycemia and normal insulinemia; T2: relative euglycemia and hyperinsulinemia; T3: hyperglycemia and normal insulinemia; T4: hyperglycemia and hyperinsulinemia. ThS was maintained in 6/8 patients at T1 and in 8/8 patients at T4. ThS was lost in 4/8 patients at T2 and T3. These data suggest that the loss of ThS induced by hyperglycemia can be corrected by hyperinsulinemia, and that it is maintained when euglycemia is accompained by hypoinsulinemia. It is lost when these two parameters lose their interrelationship.